The Neonatal Care strand aims to support NHS boards to improve the quality and safety of neonatal healthcare. The key objective is to achieve a 30% reduction in adverse events that contribute to avoidable harm in neonatal services by March 2019. This is defined by addressing harm arising from:
- mechanical ventilation
- invasive lines
- high-risk medicines
- transitions of care, and
- undetected deterioration
In addition, there is the shared aim with the maternity care programme to reduce neonatal mortality by 15% by March 2019.
The core measures, for which MCQIC will support improvement activity across all boards, for neonatal care are detailed below. All remaining measures will be supplementary.
Reduction in term admissions to neonatal units (for all units)
Risk assessment at birth
Use of early warning scores
Reduction in central line infection rates (NICUs only)
Reduction in incidence of Necrotising enterocolitis (NICUs only)
Collaborative working for maternity and neonatal care
Reduction in neonatal mortality.
Neonatal mortality rate (to focus on reduction in preterm death rate which contributes to a large proportion of overall mortality rate)
Preterm perinatal wellbeing package to include:
- Delivery in appropriate centre
- Early breast milk administration
- Administration steroids
- Administration magnesium sulphate
- Delayed cord clamping
To achieve this, MCQIC uses the Breakthrough Series Collaborative Model. Networking events are held every six months to encourage sharing and learning. These are interspersed with action periods, when local teams undertake small tests of change to improve care.
The Model for Improvement is used to support testing and implementing changes. Frontline staff are also supported through monthly WebEx sessions.
A key element of monitoring and guiding improvements is the use of data. All units are collecting and using local data to drive improvements.
A range of tools and resources for frontline staff, including the measurement plan, can be found in the SPSP Members Area and Tools and Resources below.
Why is there a need for improvement in neonatal care?
Neonatal care in Scotland is as good as anywhere in the world - but it could be better. We know that, because of their high dependency, a minority of infants suffer harm during their care episode. This harm can arise from the use of high-risk medications, the frequent need for invasive lines, unrecognised deterioration, missed screening opportunities and many other factors.
Both quality and safety are targeted by this programme. High-quality care should be reliably delivered in a clean, appropriate environment by people with the necessary skills as close to the family's home as possible. The programme also aims to ensure that best practice is agreed and shared between centres and regions to minimise variation and allow excellence while guaranteeing cost-effectiveness.
How does this align to other national initiatives?
All activities take cognisance of existing national policies and approaches, including the Healthcare Quality Strategy for NHSScotland (2010), Neonatal Care in Scotland: A Quality Framework (2013) and Getting it Right for Every Child (GIRFEC). In 2017, the Scottish Government launched The Best Start: A five-year forward plan for maternity and neonatal care in Scotland. Key recommendations from this are central to the neonatal care programme.
Other national initiatives are in progress to improve outcomes for women, babies and children. We work closely with the Children and Young People Improvement Collaborative (CYPIC) and leads of other national programmes such as Mothers and babies: reducing risk through confidential enquiries in the UK (MBRRACE-UK) and National Neonatal Audit programme (NNAP) to ensure consistency across Scottish neonatal units.
Who is involved?
Key partners involved in the neonatal care programme include:
- NHS territorial boards, including front-line staff in all neonatal units across Scotland
- Service user representatives
- Healthcare Improvement Scotland
- NHS Education for Scotland (NES)
- NHS Health Scotland
- NHS National Services Scotland, Information Services Division
- Professional organisations and colleges
- Scottish Government
What resources are available?
The emphasis is not on putting extra staff in place to deliver improvements but on existing staff ensuring reliability of care processes, so that every person every time receives the care they need and want. Consequently, there is an emphasis on boards building capacity and capability in quality improvement science.
NHS board staff are supported to undertake further development through the Scottish Quality and Safety Fellowship Programme, Improvement Science in Action and Scottish Improvement Leader (ScIL) courses, as well as providing links to online modules via NES and Institute for Healthcare Improvement (IHI).
SPSP Neonatal Networking Event, 4 October 2017
SPSP Neonatal Care held a Neonatal Networking Event on Wednesday 4 October 2017 in Glasgow. The event focused on deterioration, and gave delegates an opportunity to come together as a group to network, learn from each other and plan future improvements.
To view the presentations from the event please access the links below:
- Keeping mothers and babies together in the maternity unit (PDF)- Dr Lesley Jackson, Consultant Neonatologist, NHS Greater Glasgow and Clyde
- Programme update (PDF)– Dr Colin Peters, Neonatal Clinical Lead, Healthcare Improvement Scotland
- Theory and prediction (PDF)– Lesley Macfarlane, Associate Improvement Advisor, Healthcare Improvement Scotland
- Understanding data (PDF)– Lesley Macfarlane, Associate Improvement Advisor, Healthcare Improvement Scotland
The following are recordings and PDFs of the PowerPoint presentations from the MCQIC Neonatal Care WebEx series.
7 September 2017 - Management Strategies for Bacterial Sepsis in the Neonate by Dr Mike Hall, Consultant in Neonatal Care at University Hospital Southampton NHS Foundation Trust.
29 September 2017 - Reducing Harm from Ventilation: Chronic Lung Disease by Dr Kevin Goss, Consultant Neonatologist at Leeds Children’s Hospital.
8 November 2017 - Mechanisms to Support QI Activity by June Aitken, Senior Charge Nurse and Matt Jobson, Quality Improvement Facilitator at NHS Grampian.
6 December 2017 - Teamwork, communication and collaboration by Maria Duggan at NHS Greater Glasgow and Clyde.
Neonatal measurement plan (PDF) - April 2017
The neonatal care driver diagram (PDF) maps out the aims, outcomes and change packages for the programme.
Further tools and resources related to the neonatal care programme can be found in the Member's Area.
More Than Minutes documented our Neonatal Networking event on 6th March 2017. Below are the images they captured on the day.